Combining techniques and technologies increases adenoma detection rates in colonoscopy: More is more

Table 1 Different technological innovations and their benefit in adenoma detection rate, advanced adenoma detection rate

	Increase in ADR	Increase in AADR	Comments
Optical imaging innovation
Narrow-band imaging	No clear benefit	No benefit	Benefit in detection of dysplastic lesions in patients with inflammatory bowel disease
Blue laser imaging	No clear benefit	No benefit	Lower proximal adenoma miss rate compared to white light endoscopy in one study
I-scan	Improves ADR	No benefit
Linked color imaging	Improves ADR	No benefit	The benefit was mainly attributed to selected categories of adenomas (< 10 mm) and among low detectors
Texture and color enhancement imaging	Improves ADR	No clear benefit	Increased AADR in 1/3 studies–benefit in ADR restricted in adenomas < 10 mm
Auxiliary devices attached to the tip of the colonoscope
G-EYE	Improves ADR	No benefit	Benefit in detection of serrated polyp detection rate–not commonly accessible, paucity of data compared to cap, Endocuff
Cap	No clear benefit	No benefit	Easily accessible, one meta-analysis showing increased ADR in the proximal colon as also to increased detection of flat adenomas and serrated colonic lesions
Endocuff	No clear benefit	No benefit	Easily accessible, increase in ADR among low detectors
EndoRing	No benefit	No benefit
CADe systems	Improves ADR	No benefit	Benefit is restricted mainly to low detectors and adenomas < 10 mm
Combining optical imaging innovation with Endocuff	Improves ADR	No benefit	Benefit is restricted mainly to low detectors
Combining CADe systems with Endocuff	Improves ADR	Possible benefit	No study comparing low with high detectors exist, 1/3 available studies failed to prove any benefit in adenomas > 5 mm

AADR: Advanced adenoma detection rate; ADR: Adenoma detection rate; CADe: Computer-aided diagnosis.